Brazilian journal of anesthesiology (Elsevier)最新文献

Background: Post-spinal back pain is suggested to occur as a result of a localized inflammatory response that is often associated with some degree of muscle spasm. We aimed to evaluate the effect of platelet-rich plasma (PRP) in reducing the incidence of post-spinal back pain.

Methods: One hundred patients were randomly enrolled and scheduled for elective gynecological surgery under spinal anesthesia. After the subarachnoid block, group A (placebo) received 2 mL of sodium chloride 0.9% injected into the track of spinal needle during its withdrawal (2 mm after outward withdrawal in muscles and subcutaneous tissues). While patients in group B (PRP); received 2 ml of PRP injected into the track of the spinal needle during its withdrawal. The primary outcome was the number of patients who developed post-spinal low back pain within the first week following the subarachnoid block. Secondary outcomes included the time of the first analgesic request and total meperidine consumption during the first 24 h postoperatively.

Results: Fifteen patients in the PRP group developed low back pain during the first week following subarachnoid block compared to 26 patients in the placebo group (p = 0.037). There was a significant decrease in the mean meperidine consumption during first 24 h postoperatively in PRP group (174 ± 14 mg) compared to placebo group (210 ± 22 mg) (p < 0.0001). Also, the first analgesic request was significantly delayed in PRP group (243 ± 21 min.) compared to placebo group (185 ± 31 min.) (p < 0.0001).

Conclusion: This study demonstrated the positive effects of platelet-rich plasma on the prevention of post-spinal backache.

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The care for patients suffering from cardiopulmonary arrest in a context of a COVID-19 pandemic has particularities that should be highlighted. The following recommendations from the Brazilian Association of Emergency Medicine (ABRAMEDE), the Brazilian Society of Cardiology (SBC) and the Brazilian Association of Intensive Medicine (AMIB) and the Brazilian Society of Anesthesiology (SBA), associations and societies official representatives of specialties affiliated to the Brazilian Medical Association (AMB), aim to guide the various assistant teams, in a context of little solid evidence, maximizing the protection of teams and patients. It is essential to wear full Personal Protective Equipment (PPE) for aerosols during the care of Cardiopulmonary Resuscitation (CPR) and it is imperative to consider and treat the potential causes in these patients, especially hypoxia and arrhythmias caused by changes in the QT interval or myocarditis. The installation of an advanced invasive airway must be obtained early and the use of High Efficiency Particulate Arrestance (HEPA) filters at the interface with the valve bag is mandatory; situations of occurrence of CPR during mechanical ventilation and in a prone position demand peculiarities that are different from the conventional CPR pattern. Faced with the care of a patient diagnosed or suspected of COVID-19, the care follows the national and international protocols and guidelines 2015 ILCOR (International Alliance of Resuscitation Committees), AHA 2019 Guidelines (American Heart Association) and the Update of the Cardiopulmonary Resuscitation and Emergency Care Directive of the Brazilian Society of Cardiology 2019.

Background and objectives: Skin fragments during lumbar punctures may develop intraspinal epidermoid tumors. The aim of this study was to determine the incidence of epithelial cells that reflow along with the fi rst and third drops of CSF of patients undergoing spinal anesthesia.

Methods: Samples of the fi rst and third drops of cerebrospinal fluid were collected from 39 adult patients undergoing spinal anesthesia with a 25G Quincke needle. Four microscope slides were prepared: one for the fi rst drop, one for third drop, one for the needle, and one with a drop of saline for control. A pathologist examined the slides randomly.

Results: Squamous epithelial cells were identified in 35 (89.7%) samples from the fi rst drop, 34 (87.2%) from the third drop, and 24 (61.5%) from spinal needle. The third drop showed a mean number of cells larger than the fi rst drop (p = 0.046). Nucleated epithelial cells were found in a sample of the fi rst drop (2.56%), in four samples of third drop (10.25%), and in one spinal needle (2.56%). Third drop showed a mean number of nucleated cells higher than fi rst drop with no statistical difference (p = 0.257).

Conclusions: High percentage of epithelial cells was found in the fi rst (89.7%) and third (87.2%) drops of CSF reflow and in used needles (61.5%). Skin cells were found even using small gauge disposable needles with well-adapted mandrel.